February is a month of LOVE and hopefully we are showing our family members and friends how much we appreciate them. Unfortunately, having increased sexually activity can sometimes lead to unwanted infections of the urinary tract. What are some ways we can be more aware of this condition and prevent it?
1) What exactly are urinary tract infections?
Urinary tract infections are bacterial infections of the bladder (lower urinary tract) and/or kidneys (upper urinary tract). When the infection is in the lower urinary tract, and presents with symptoms of painful urination, urinary frequency, urgency, and sometimes tenderness in the lower abdominal area and blood in the urine, the infection is called cystitis. When the infection travels up to the upper urinary tract, it usually implies there is significant bacterial load to travel up to the kidneys, and occurs with flank or back pain as well as a fever. When this occurs, it is called acute pyelonephritis. Urinary tract infections are common, and an estimated 11% of women in the United States report at least one infection per year. The lifetime probability that a woman will have a UTI is 60%.
2) What are some risk factors of urinary tract infections?
Most cases are caused by bacteria ascending into the bladder from the urethra. Women are more likely to have UTIs than men because the urethral distance is shorter. Bacteria is introduced to the lower urethra through sexual intercourse, mechanical instrumentation, or urethral massage. The primary bacteria that causes UTIs is E coli. The remainder of infections are caused by other bacteria, such as Staphylococcus saprophyticus, Proteus, Psuedomonas, Klebsiella, and Enterobacter species. The risk factors in premenopausal women include frequent sexual activity, use of diaphragms or spermicidal agents, diabetes, obesity, kidney stones, anatomic congenital abnormalities, or any other neurological or anatomical conditions requiring an indwelling bladder catheter or frequent catheterization. In postmenopausal women, UTIs can occur because of vaginal atrophy, poor hygiene, diabetes, and pelvic organ prolapse.
3) How are these infections properly diagnosed and treated?
Urinary tract infections are usually diagnosed by sending off a urinalysis and urine culture. It is best to give a clean catch specimen by collecting the specimen mid-stream, and after wiping the external urethral area with a clean wipe. This will decrease bacterial contamination in the specimen. Whenever a doctor asks for a urine specimen, first try to wipe down the external area, start urinating, and collect the specimen mid-stream if possible. Another option is to collect urine is to catheterize the bladder.
The primary way to treat urinary tract infections is by taking in antibiotics. Usually, treating uncomplicated cystitis with about 7 days of antibiotics therapy will treat the infection. Recent data has shown taking antibiotics for fewer days also can be effective. It is not recommended to take antibiotics whenever you develop symptoms for a shorter course of time unless directed by a physician, as this can increase the rate of antibiotic resistance. Please consult with your physician to know which antibiotic is the right one to take.
4) What are some ways to prevent these infections?
Any activity that will introduce bacteria to the bladder will increase chances of a urinary tract infection to occur. Therefore, limiting exposure to the urethral area will also decrease chances of bacterial infection. Maintaining good hygiene by washing in the genital area at least once daily, limiting exposure of touching in the genital area, decreased use of diaphragms and menstrual cups will help, and decreasing sexual activity. In addition, cranberry supplements, and voiding or washing immediately after sexual activity can also assist in prevention of infections as well.
As always, consult your physician for additional information on this topic, and seek medical attention if you are having significant abdominal pain or discomfort with urination.
(1) Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med 2003;349:259–66.
Jennifer E. Cho, MD, FACOG